Tag Archives: change

Are you digitally ready?


The essence of the session I presented at #NIPEC18 today

Are you digitally ready?  I am hoping I am!

Maybe you are expecting a technical presentation; this is not that.  That’s because I actually believe that this whole agenda is about people.  Its not about a list of technical capabilities – its about how people respond to technology and its about everyone in this room, so how do you know if you are digitally ready?

First of all, for context, I would like to reflect back.

Its 1983 and I am a fresh faced student nurse. Much of the technology we have now didn’t even seem possible then.  We had no mobile phones and as a patient I was boiling my insulin syringe in a pan in the kitchen.

Over the decades since then I have assimilated technology into both my professional and my personal life, as I am sure you have too.

I have had no training in any of these things but I bank online, I order my meds online, I look loads up on google, I have an insulin pump and a Continuous Glucose Monitor.  I love the connections I gain on social media and I use this in both my social and professional life.

I feel I am digitally ready in many senses.

But what is it exactly that makes me so?

Here are the 5 characteristics that I think make me digitally ready:

The first is that I am change positive; that is I have a positive professional orientation towards change, seeing it as an opportunity rather than something to be avoided.  I like doing novel things.  I was the first complaints manager at our Trust, I was part of the team that set up NHS Direct, a nurse led telephone triage service and I think was one of the early nurses to work in an informatics role.  I experiment (safely of course) all the time, like I am experimenting today with you, presenting without slides.  You will have to let me know how it goes!

For me being change ready means exactly that, prepared to try new things, experiment and play.

I believe that all nurses need to be change positive as nursing as its taught today is unlikely to be the nursing of the future.  The pace of change is ramping up and technology is a large part of that, for example genomics and personalised medicine is likely to be come a reality in my lifetime.

I have already seen significant professional change. I used to be a staff nurse on a cadiology ward.  The only way we could do surgery on someone’s lungs was a large incision in someone’s chest.  It took days for them to recover.  It was painful. Now, today they can do this type of surgery using keyhole surgery. Think of the massive difference it makes.  It improves recovery but just think about the changes it makes to caring for these people!  It shifts the focus for nursing too.  And I predict it will be robotics next.

Being change ready is a good life skill as well as a professional skill too!

The second trait is Curiosity, when I mentor people I always advise them to remain curious.

Curiosity drives progress.  If we are not interested in ‘what if’ then things will always stay the same.

Curious people can be intimidating though – they challenge the status quo and make people feel uncomfortable.  I have often asked developers difficult questions about the art of the possible and hopefully driven better outcomes for patients as a result.  Its part of being able to see a wider perspective and to be able to see how technology and data can be used to a fuller strategic perspective.

So what am I currently curious about?  If we want to care for more people at home how can we lever technology to help?  I visited a brilliant care home near Coventry last week where these are using noise detectors in a large home to help to identify when things happen at night.  This increases rather than decreases privacy as it prevents the night staff having to actually go in to rooms at night for checks which in turn frees them up to support people who don’t sleep and focus on their ‘Wide awake club’ meaning care overall improves (and falls have reduced too).  I am interested in technology like Alexa and exploring how we can use it with patients.  Artificial intelligence too……. I could go on…… technology is a rich seam of interesting stuff for a curious person.

Curious people often have great imagination too and can describe how things might be, having conversations, visioning, and leading strategic change.

The third trait is a relentless focus on improvement.

I care deeply about the experience of people we care for, their carers and families.  This is fed from my own long term condition but everyone has the potential to empathise.

Sometimes the status quo is fine when you are on the right side of the service.  But it might be less so when you or your loved ones are unwell.  It changes the dynamic and you suddenly have what I call ‘real skin in the game’.

An example:

This week I received a letter from my GP.  It pointed out that I have a prescription for pre-filled insulin pens but I have no prescription for needles and it enclosed a  leaflet on how to give injections.  It concluded that they had set up an prescription for me to have needles.

What they failed to do was check my record.

The data they hold about me should have told them that I have an insulin pump.  I only use pens as a back up and rarely use them.  I have a box of 100s of needles prescribed 10 years ago that I have yet to use.

If the people focused hard on improvement using data they would have realised a number of things:

I am a pump user so don’t need many needles

I have had diabetes since 1979 and maybe sending me a leaflet about giving injections was slightly patronising (I suspect I have given more injections than the practice nurse).

I think using data is an important part of improvement science.  But use it well. Focus on outcomes and do proper PDSA cycles.

I would love to know what outcome they expected when they sent me the letter.

Improving my injection technique might be the aim and I am grateful for that but they need to use the data in a better way.

Data is the lifeblood of improvement science.

If they wanted to make things better what outcome are they measuring? And how will they judge if they have made a difference.

Nurses who are digitally ready focus on service improvement informed by data!  I can’t stress strongly enough that a digital ready nurse understands the value of data and the contribution it makes to better outcomes.

My fourth point is resilience.  Its quite a trendy word right now so what exactly do I mean?

Resilient people keep trying.  They are bouncy and in this instance keep advocating for the technology no matter how many times they are shouted down or doors slammed in their faces. When you innovate using technology it doesn’t always go well but you have to keep adjusting, reframing until you get the best outcomes.

Its OK to say ‘That didn’t work did it?  Now how can we try to make it better?’  It takes a particular tenacity and resilience to safely fail and keep trying.  It’s a mind set.  I suppose another word for this might be an optimistic mindset.

I honestly think that technology and data create a great opportunity to make the lives of patients and nurses better.  But it’s a journey. Its not a one off.  It takes hard work, as an ongoing endless journey.

I have been in this space for 17 years and I have often felt like I was talking to myself.

Things are changing but digital nurses need to not fall over at the first hurdle but believe data and technology CAN make things better.

Finally trait five!

Networking and learning from each other.

I believe in stealing other peoples good ideas and building on them, if it improves care.  I don’t mean stealing patents, and those type of ideas, but I do mean the sort of mentality that looks around to see what other people are doing to see what you can learn!

Social media is one way of doing this.  Digital in this sense has created a whole new way of learning and communicating across the world.

Networks are a fantastic way to feed your curious traits, or your creative skills.  I urge you to connect and look around.  Are you well connected?  Do you have fantastic networks?

I am lucky that I am often these days asked to judge awards.  It shocks me how often nurses describe their projects to us and see them as unique, special – when in fact the trust in the next county or in NI or Scotland or wherever, are doing the same thing better!  Just think of the potential of networks when they are cumulative for the development of ideas.

Networks are generous spaces; if you don’t believe me take a look at the Fab NHS Stuff site where people are generously sharing their ideas.

So, finally – why do I think I might be digitally ready?

The five characteristics:

I am change positive, curious and relentlessly focussed on improving the experience of service users and importantly outcomes.  I am resilient, prepared to try new things and learn from others.

How are you digitally ready?

curiosity and my cat 🙂

Guest Blog: Compassion – a MARLARKEY or a CASE FOR CHANGE?


Maxine 2014This is a guest blog from my friend and colleague Maxine Craig who is Head of Organisation Development at South Tees NHS Trust and visiting Professor ( Sunderland University).

Maxine can be found on Twitter on @Maxine_craig and she would welcome conversations about this blog.

Maxine’s blog speaks for itself – so here it is:

This week whilst at a training event in the coffee break a lady approached me and asked me “Was I Maxine Craig who is part of this ‘NHS Compassion Malarkey’? ” – now this has hit a nerve!

Maxine nursing

I have worked in the NHS since I was 17 and this ‘malarkey’ has been my life for 33 years. Ensuring patients get the best we can give and staff are well and healthy is my purpose. It’s no malarkey!

 

This is what a malarkey is:

malarky

I believe there is a compelling case for change in the delivery of care; the latest Panorama programme surely reinforces that? – Yet I sense that a back lash about compassion is building.

For the past year I have been making myself available to help people think about the issues we face, making spaces where people can think more deeply about compassion in our lives. And I am learning that everyone I speak to in the NHS, social care and wider society recognises that something about it needs fixing. Everyone appears to have a perspective on the general lack of compassion in the wider world and that the NHS needs to ‘do’ compassion better.

elderly lady

This is a real puzzle for me. I work in a great organisation and I witness compassion every day, in abundance, and I see situations where compassion in lacking; It’s not as clear cut as the media would have everyone think. I am worried that being compassionate is becoming an industry in our health and social care settings, others also express this view and some are becoming cynical of anything with a compassion label. I would like us to pick out and continue the genuine good work.

In all of my learning I have found that people find talking about compassion rather uncomfortable. Yes, everyone has an opinion, a surface view. Some people have been deeply affected by a positive experience of compassion in their lives and some hurt by a gap in compassion. Everyone who comes to talk about compassion has some interest, and I have noticed that many have some degree of discomfort.

angry womanI think this is because it’s about all of us, not just the bad guys who don’t do it! It has the potential to make us feel guilty, uncomfortable about our personal struggles and challenges.

At a system level the NHS voices that it wishes to improve compassion but it continues to work in a non-compassionate way and I suspect the care sector is the same. This is a paradox. I do not believe this is a ‘problem’ that needs to be solved but see it as more of a societal context, leaving me as an OD practitioner with a complex and sometimes frustrating dynamic to work in. So I am working to explore and practice the ‘HOW’ of increasing compassion in our system – I want to get on and DO something about it not just talk about it!
 

The NHS is deeply evidence based. In some parts this might be more espoused theory than theory in use, but it is an important guiding principle. We also wear the cloak of evidence as a defence. Another important fact is that many professionals and managers (and I include myself in this group), actually were professionally socialised at a point in time when the control of emotions and ‘not getting emotionally involved with the patient’ were prized professional competences. The new world of the psychology of work offers a different view, with burn out, compassion fatigue and emotional labour as key and important phenomenon. It is important we remember the shift which has occurred within one generation. As a result of this shift the current reality of the compassionate intervention is very challenging for some.

the compassionate mindSo I have learned that the very best way into these conversations about compassion and the psychology of work and caring is via the science. The work of Paul Gilbert who established the Compassionate Mind foundation gives us the basis of the neuroscience of emotion (you can read more here) and I have been able to link this to stress in life and wider society.

Tree huggingI have witnessed the relief in people when they come to talk about compassion and are met with the evidence base. It welcomes them in, it is a context they know, it allows them to be open to the practice of compassion. When coming to a talk about compassion people have shared with me that they were worried it would be too soft and fluffy. When I have explored what this means some people say they don’t want ‘new age’ or religious or spiritual. So like all good change agents let’s start where people are at – let’s start with the science!change agent

Compassion is no malarkey; it’s vital and too important to be pushed aside because it makes us uncomfortable.

I am DIGGING IN for the long haul on this one – I want to make sure the NHS and care system is good enough for my dad. Will you join me?

Maxine's Dad

Where is your change preference?


figure headSometimes life throws you an opportunity to explore something new or even explode things you thought you knew. Often you think you know what enthuses you but then you surprise yourself; I once surprised myself white-water rafting in the Ottawa River – I was like the figure-head on the front of a ship, holding on bravely – but I digress! This time it was a new opportunity to explore and expand some knowledge.  As part of my Florence Nightingale Foundation Burdett Scholarship I have been very lucky to spend some time at Roffey Park  and a few weeks ago I was there looking at change management.

So we looked at a number of theoretical change models. That was interesting enough; I knew some and was less familiar with others. Then the interesting bit started, we tried putting them along a scale according to what I have termed humanist > mechanistic approaches. What I call humanist are what is termed ‘relational’ where enabling techniques like World Café, Future Search and Appreciative Inquiry have their place. At the opposite end of the spectrum was more mechanistic project management type approaches, that are less messy and are organised in a more logical flow led by theorists such as Lewin and to a degree Kotter; they have a more linear and analytical style with techniques like business process mapping and lean methodology. Of course the scale is not a scientific one and it is matter of personal interpretation and perspective.

change

I had a sudden moment of clarity. The process of learning led me to think about my personal preferences and how I liked to think about change. I discovered that although I see that different approaches have different strengths and weaknesses, I had a personal preference for the type of approach to change that I liked to be involved in. I also saw that not only had I personal preference for any approach to change, that I worked in organisations that equally had a culture with a leaning towards an approach, and finally that there was an opportunity for discomfort and tension in this.

BridgesMy favourite model was a new one to me and is a model called ‘Transition Management’ based on the work by William Bridges. It refocuses change into transition, which is the psychological transition and reorientation required in response to change. I loved the idea that before we can transition we need to address endings and then we inevitably experience a neutral zone, a period of chaos and an in-between time. Then the process of renewal starts. I loved the language of this model. Words like: endings, relationships, resistance, disorientation, beginnings and new identity. If you want to know about Bridges have a look at this article here.

Gant chartSo, I like a particular approach to change but I work in an area that clearly can’t use that approach, you can’t introduce new software using appreciative inquiry – you need good Gantt charts plenty of them! If you work in the large scale programmes I work in you are nobody if you don’t have a Gant chart or a RAG status!  But I survive there despite my preferences – I had to think hard about why!

My conclusion was that I am able to see that its appropriateness that matters most and having people around who have the skills to use the right approach. Organisational development people are not one-trick ponies they need to be able to work out what is the best way and then use it. I’m just glad that with my preferences for relational models of change I work with some great people who have skills at the other end of my change spectrum – It made me think about difference and value it even more!

At a time where there is a need for unprecedented change in the NHS, understanding our personal preferences and leanings as well as the embedded culture of organisations and their almost instinctive responses to the need for change has to be important learning.

standing out from crowd